MEDICARE: KAYCI RACCA THOMAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	234785	LA

General Provider Information

NPI Number	:	1174365126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYCI RACCA THOMAS

Provider Business Mailing Address
First Line	:	217 BOURG ST
Second Line	:
City	:	JEANERETTE
State	:	LA
Zip	:	70544-3503
Country	:	US
Telephone Number	:	337-276-7002
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 BOURG ST
Second Line	:
City	:	JEANERETTE
State	:	LA
Zip	:	70544-3503
Country	:	US
Telephone Number	:	337-276-7002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/11/2024

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Directions to “ KAYCI RACCA THOMAS ” Practice Location

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